02/21 - Bandit - AMPS (271) +3 (265) +8.5 (301) - Suddenly lost the good numbers!

Previous post - http://www.felinediabetes.com/FDMB/...06-5-110-9-153-pmps-228-2-56-how-what.225684/

Looks I DID jinx her by posting when she had a great blue streak a few days back! Only a sea of yellow since. Even the dose increase isn't doing anything.

Her appetite is a little lower but I would attribute that to the warmer temperatures we have been seeing. She is grazing through the night and not eating very much during the day. That's the way she has always liked it. Can't seem to get her to eat only at shot time or pre-nadir!

 

On your last post, you said you'd reduce the dose because of the 56. You are following SLGS so the reduction was well earned. Instead, you increased?

 

My sister didn't agree to the decrease
She felt that Bandit's numbers were overall in the higher range. Plus with her history of failed reductions and the requirement to hold a possible failed reduction for 7 days, she wasn't willing to take the risk. We compromised and decided to hold the dose but the numbers only went higher after 6 cycles of holding the dose. Enough time for any bounce from the previous lows to clear.

Do you get the sense that Bandit is on more insulin than she needs? That she would do better on a lower dose?

P.S. I realize that I'm asking for advice after not listening to advice previously given!

 

301 at +8.5. She seems fine on the whole - as fine as she's been (with her hind leg weakness restricting her mobility).

Can't understand why her numbers are going up like this. Do we need to go higher with the dose?

 

I hope someone experienced will reply to you. I Guess u can always decrease and see if it works.

 

I'm not sure where that philosophy got started but it's incorrect. Sometimes when there's a certain dose held for a long time - usually a higher dose than this there are some cases where there are 'things' going on...but I'm not seeing that as the case here...

As per SLGS you need to hold the dose for 14 cycles (7 days), if no green numbers, then you increase.

From the SLGS protocol: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

If in doubt, re-read the protocols and steady as she goes...you may get a pleasant surprise soon...but you really do need to try to follow the advice of the protocols regardless of how you're feeling at the time - this time it worked out because Bandit's numbers went back up. There are cases when caregivers did not heed the advice and the next day was a nightmare of low numbers and fighting hypo with test/feed, test/feed and karo syrup...it's not a fun day...

Are you on SLGS because of the kibble? Wondering why you don't switch to TR, then you would take reductions if he falls below 50 or lower....just wondering. It looks like you test enough for TR.

 

@Sue and Luci
She is on SLGS due to dry food. No low carb wet is available where she lives. It’s great she has a way to at least get the low carb dry.

 

I understand and I do not take advice lightly. And I appreciate the time and experience of members here. Were not for this forum, I would have been lost. I spoke to my vet a couple of days back regarding running another round of blood tests and he said Bandit's current BG range of 150-300 was fine and not to bother!

I also understand that TR can be done with wet food only and I appreciate that there is no precedent/not enough data for TR with zero carb kibble and therefore the reluctance to give dosing advice for TR with dry food.

However, I think I have gotten to know Bandit (as well as it is possible to know FD) and I think I test her enough to keep her safe. At the same time, I do not want her to be penalized for being in a country with limited facilities for pets. When I see her limping around (her hind leg weakness seems more pronounced these days despite lower numbers than a month ago) I cannot bring myself to wait weeks and weeks to find the right dose. I do not see Bandit's numbers going low enough to merit a reduction that will not fail. I could be wrong. I would like to think that I can keep her safe and would like to follow TR. Or at least SLGS with a reduction point of below 50 (like in TR).

I could really really use the experience of senior members of this forum but I do not have the luxury of time. It would be a huge support to me to have people here guide me - even though I am not playing by the rules - and that is only due to the constraints I face here.

ETA: I am not in a rush to get to remission. Just to get Bandit to lower numbers to help relieve her symptoms.

 

I don't think you can mix TR and SLGS dosing methods just because ...I have taken a modified reduction number for SLGS but even it isn't that low (below 50 is really low) and we are on wet, LC food.

I don't think it is about testing enough - it seemed to me to be about predictability. From what I read on the post here on this page about the differences between dry kibble in doing TR vs SLGS it was the same statement folks on here have said... not just that there isn't enough information for TR with dry, but that dry food as a variable is just less predictable in regulating BGs and using it to intervene during the cycles. On top of that .. you free fed, right?...so the meals aren't even the same from injection to injection which cause some variability in blood sugars in and of itself. It does seem like too many variables to me...lots of moving parts.
Can you intervene with food like some others can when the cats need to be a little carbed up at the +1 and +2 even with some of the food limitations you have?....seems some of the advice that is given for others as far as just shooting a lower number and giving some food to ride out the onset might not look the same for you with the free feeding and limited LC,MC,HC options- I could be wrong but it's worth asking and getting a plan together...

this is from that post : from a member/moderator since 2008

DRY FOOD AND TIGHT REGULATION PROTOCOL

The bottom line here, in my estimation, is that we just don't know how dry food will affect regulation. The Tight Regulation Protocol is very aggressive and we cannot afford to have unknowns when we are letting cats run below 50 on insulin. I personally am not willing to take that risk with someone else's cat.

From a personal perspective, my cat Kris Kringle ate dry food due to other health issues. I didn't necessarily find his numbers to be higher with dry food, but they were definitely unpredictable (and after all these years I'm usually pretty good at understanding numbers). I tried to keep him over 60 so I would have time to intervene if he threw me a curve ball. Are chances of remission as good if you do not let them run lower? Probably not, but I'd rather have my cat alive and on insulin than dead because of an error in judgment.


PLEASE REMEMBER

The Tight Regulation protocol is aggressive, and our modified version is slightly more aggressive than the original. We feel safe allowing our cats on Tight Regulation to run as low as 40s because we know the dose is a safe one for that cat at that time. We know that because of the way we work up to a dose, and the way we work down from a dose. It is not about the number of tests or how many cycles a dose is held, it's about gathering the RIGHT data rather than just a lot of it.
Cats following SLGS will probably not have all of the safety nets in place, therefore you will probably not be able to approach 50 with the same confidence that the cat is safe. If you are sure that low numbers are ok for your cat, that is fine, but please do not ask anyone else to tell you it is safe. In my mind, if you are asking, that means you are not confident so I will probably steer you back toward the guidelines.


I also think that not wanting to wait "weeks " to find the right dose doesn't specifically mean that if you decided to try TR that you would not necessarily have to stay on a dose for weeks at a time. I have looked at several SS for those on TR and once they started to find the occasionally blue- the doses were held for weeks- then nice greens...the same thing. Held the dose for awhile...sometimes they had to go back up and sometimes they got to reduce again.
The right dose is the one that works for your cat.

I'd say either adjust the amount of time you hold a dose - maybe try 5-6 days before an increase to start OR think about modifying the number you take reductions to below 80 or something for awhile- but NOT both. Especially if you aren't able to feed meals at set times to at least control the food variable and aren't testing past the +6 mark because you don't think you need to.

Not criticizing at all...just worried and trying to helpful plus offer solutions.... and again...I'd rule out arthritis/ age changes with the limping...

 

I've seen you aren't the only one who feels this way also ...frustrated with the diet limitations of TR. Maybe posting something in the " think tank" would get some other opinions or options into the mix since not everyone comes into the specific insulin boards either ....Maybe someone else has another way of dealing with the two dosing methods in comparison with just chucking the SLGS reduction number...
Just curious

 

thanks for taking time to reply in such detail, @Si am cat mom .
i have already read everything on this board about TR and dry food including the posts you quoted - i am just not convinced about the logic to reduce below 90 (especially if it is one random drop in a sea of yellows and pinks) and especially hold a failed reduction for a whole week.

but i do get your point about holding the dose for weeks and finding good numbers eventually on the same dose. i find that Bandit's numbers haven't improved significantly with the increase from 1.75 to 2.50. she seems to be stuck in the same range. i don't know if that means i need to keep increasing or if holding the dose would be more beneficial - to allow her body to get used to lower numbers and reduce the bouncing.